Exam 2

Question 1

Hypoglycemia

Answer 1

BG < 70 mg/dL

Severe <50 mg/dL

Question 2

Euglycemia

Answer 2

BG 70-140 mg/dL normal

Question 3

Hyperglycemia

Answer 3

Post prandial BG >140 mg/dL

Question 4

Pathophysiology of glucose

Answer 4

Glucose: Enters blood from intestines (food consumed)
Pancreas: regulates blood glucose. 
Secretes Insulin: LOWERS BG
Secretes Glucagon: INCREASES BG
Type I DM - insufficient insulin production
Type II DM - 
Gestational (pregnancy)
Medicine induced
Stress or hospital-induced

Question 5

Consequences of Hyperglycemia

Answer 5

Short-term consequences 
Inadequate glucose reaching the cells
Dehydration
Long-term consequences
End-organ disease due to microvascular damage
Retinopathy
Nephropathy
Peripheral neuropathy
Macrovascular angiopathy
Hypertension
Cardiovascular and peripheral vascular disease

Question 6

Consequences of Hypoglycemia

Answer 6

Irritability
Fatigue
Mental confusion 
Seizures 
Unconsciousness
Potentially leads to cellular death

Question 7

Blood Glucose: Signs & Symptoms

Answer 7

HYPOglycemia:

Shakiness
Dizziness
Sweating
Hunger
Irritability or moodiness
Anxiety or nervousness
Headache

HYPERglycemia:

Frequent urination
Hunger
Thirst
Fruity- smelling breath
Weakness
Weight loss
Fatigue
Blurred vision
Trouble concentrating
Nausea & Vomiting

Question 8

Risk factors for blood glucose

Answer 8

Risk for impaired glucose regulation
Age
Racial and ethnic groups
Family history 
Lifestyle
Medical risk factors 
Selected medications

Question 9

Assessment of blood glucose regulation

Answer 9

Current medications
Personal or family medical history markers
Central obesity
Diabetes
Hypertension
Cardiovascular disease
Cancer
Review of symptoms
Lifestyle Factors

Question 10

Primary Prevention of blood glucose regulation?

Answer 10

Diet, exercise, and weight control

Question 11

What labs and screening are needed when caring for a patient with blood glucose issues?

Answer 11

Lab test - hemoglobin A1c, Point of care, and serum glucose.

Screening to detect complications - Blood pressure, Dental, foot, and eye examinations.

Question 12

What would be involved with patient education?

Answer 12

Education:

Glucose Regulation
Diabetes: The Basics
Sick Day Management
Nutrition 
Diabetic Diet
Carb Counting
Insulin Administration
Types of Insulin
Oral Agents
Procedure Steps/Safety

Question 13

What are the types of Insulin?

Answer 13

Rapid-Acting
Humalog, Novolog

Short-Acting
Humulin, Novolin

Intermediate-Acting
Humulin N, Novolin N, NPH

Long-Acting
Insulin Glargine

Question 14

What are the forms of insulin delivery?

Answer 14

syringe, pen, pump, and inhaler

Question 15

Low Blood Glucose (Hypoglycemia)

Causes, Symptoms, and Treatment

Answer 15

Causes:
Too much insulin or diabetes pills
 Late/skipped meal or smaller than usual meal
 More activity/exercise than usual
 Alcohol intake without food
Symptoms (happen quickly)

Symptoms:
 Shaky, sweaty or clammy
 Light-headed, weak, blurry vision
 Hungry, irritable, anxious or confused
These are the most common symptoms. Get to know your symptoms and act quickly. If not treated quickly, you may lose consciousness.

Treatment Options
(if able to swallow)
Get treatment quickly. Take 15 grams of quick-acting carbohydrate (sugar). Examples:
 4 oz. (1⁄2 cup) juice or regular (non- diet) soda
 Glucose liquid or gel (read label for amount)
 4 glucose tablets (chew them)
 Soft, chewable candy (amount varies)
Check your blood glucose 15 minutes after treatment. If your glucose is still below 70 mg/dL, repeat treatment.
Call 911 if you feel too sick to eat or if the glucose levels stay below 80 mg/dL after 30 minutes.

Question 16

High Blood Glucose (hyperglycemia)

Causes, Symptom, and Treatment options

Answer 16

Causes:
 Not enough or missed dose of insulin or diabetes pills
 Less activity than usual
 Overeating
 Illness (cold, flu, infection)
 Pain or injury
 Stress (physical or emotional)
 Some medicines (such as steroids)

Symptoms: (happen over time)
 Thirst, frequent urination
 Nausea/vomiting
 Unexplained weight loss
 Slow healing or frequent infections
 Fatigue or sleepy
 Blurred vision
These are the most common symptoms. Many people do not have symptoms until glucose levels are very high, but this varies for each person. If not treated, high blood sugars can be life-threatening.

Treatment Options:
Insulin is often used to treat high blood glucose levels. If you do not use insulin, talk with your health care team about what to do. It is not always best to exercise or to eat less to lower your glucose levels. Discuss this with your health care team. If you are sick, follow sick day guidelines.

Question 17

What are the nutritional requirements for adolescence

Answer 17

Adolescence characterized by rapid physical growth and endocrine and hormonal changes
-Caloric and protein requirements increase to meet this demand, and because of bone growth and increasing muscle mass (and, in girls, the onset of menarche), calcium and iron requirements also increase
-Increased requirements cannot be met by three meals per day; therefore, nutritious snacks play an important role in achieving adequate nutrient intake
In general, boys grow taller and have less body fat than girls

Percentage of body fat increases in females to about 25% and decreases in males (replaced by muscle mass) to about 12%
Typically, girls double their body weight between the ages of 8 and 14
Boys double their body weight between the ages of 10 and 17 years

Question 18

What are food diaries

Answer 18

Takes time to complete, can be quite tedious
Three days, including two weekdays and one weekend day, are customarily used
Best: Record immediately after eating
Potential problems with food diary
Noncompliance
Inaccurate recording
Atypical intake on recording days
Conscious alteration of diet during recording period

Question 19

Low fat and low sodium foods

Answer 19

Saturated & Trans Fats: Limit saturated fats to less than 10% of total calories daily by replacing them with unsaturated fats and limit trans fats to as low as possible.

Diets high in saturated and trans fats are associated with heart disease. Foods high in saturated fats include butter, whole milk, and meats that aren’t labeled lean. Trans fats are in processed foods, like desserts, frozen pizza, and coffee creamer.

Sodium: Limit to less than 2,300 mg daily (for adults and children 14 years and older).
Most Americans get 50% more sodium than recommended. Diets high in sodium are associated with high blood pressure and heart disease.

Question 20

BMI calculation

Answer 20

Kg/m^2 = BMI
(you will NOT be given this on the test)

1ft = 0.3 meters (you will be given this conversion on the test)

Scenario: 200lbs , 6ft patient

Find Kg: 200lbs/2.2lbs = 90.9 kg

Find meters: 6ft x 0.3m = 1.8 meters

1.8 meters squared = 3.24

91/3.24m = 28.08

(for final answer, round to nearest whole #; 0.5 and over = round up)

BMI: 28

Question 21

How do you inspect and auscultate during respiratory assessment?

Answer 21

Inspect:
Skin, color, lesions, scars
Chest shape and configuration
Effort of breathing

Auscultate:
Anterior lungs : 3L/3R spots
Posterior lungs : 3L/3R spots
Lateral Lungs : 1 spot L & R

Question 22

What are adventitious lung sounds?

Answer 22

Crackles or Rales: Crackles are caused by the “popping open” of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration.

Fine: smaller airways
Coarse: larger airways

Wheeze: A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing.[1] For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed

Rhonchi: a snoring sound that comes from secretions within the airways

Stridor: Stridor is an abnormal, high-pitched, musical breathing sound. It is caused by a blockage in the throat or voice box (larynx). It is most often heard when taking in a breath.

Question 23

How do you auscultate breath sounds?

Answer 23

Progress from side to side and move downward, listening for one full breath in each location.

*Note: do not place stethoscope directly over female breast; displace tissue and listen over chest wall.

Question 24

What is inadequate perfusion?

Answer 24

Inadequate perfusion- when blood cannot transport oxygen to cells and return carbon dioxide to alveoli (decrease cardiac output, emboli, vasoconstriction)

Question 25

What is reduced capacity of gas exchange?

Answer 25

Reduced capacity for gas transportation (reduced hemoglobin and/or red blood cells) There just aren’t enough to do the job.

Question 26

What is ineffective ventilation?

Answer 26

Ineffective ventilation: can occur if oxygen isn’t available (high altitudes), or disorders affecting nasopharynx and lungs (spinal cord injury, rib fracture, bronchoconstriction like asthma or obstruction from things like cystic fibrosis or chronic bronchitis)

Question 27

What is the consequence of severe, unresolved impairment in gas exchange?

Answer 27

Reduced oxygen in blood (hypoxia or absence of oxygen in blood (anoxia)

Oxygen deprived tissues

Then Cell death

Question 28

S2

Answer 28

aortic and pulmonic valves

Question 29

S1

Answer 29

tricuspid and mitrial